Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

BACKGROUND: Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system.AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures.MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors.RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95%CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age ≥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation ≥ 2.5 hours (OR 8.38; 95%CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01). CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit

Maternal and Neonatal Effects of Vasopressors Used for Treating Hypotension after Spinal Anesthesia for Caesarean Section: A Randomized Controlled Study

AIM: The aim of the study was to examine whether ephedrine and phenylephrine were different in their efficacy for managing maternal hypotension and their effect of adverse maternal and neonatal outcome.METHODS: A double-blind randomized controlled study in healthy pregnant women ASA physical status 2, which underwent elective caesarian delivery under spinal anesthesia. Patients were randomized to receive an intravenous bolus of either phenylephrine (Ph group) or ephedrine (E group) immediately after the episode of hypotension after spinal anesthesia. Maternal and neonatal outcomes were recorded.RESULTS: Two hundred and two (202) pregnant women at term were entered in this study. There were no differences between group E and group Ph regarding the incidence of hypotension after vasopressor therapy, and the incidence of nausea and vomiting. There was no significant difference between groups in the first-minute and the 5th minute Apgar score, none of the neonates had the true fetal acidosis.CONCLUSIONS: Ephedrine and phenylephrine have the same efficacy in treating hypotension after spinal anesthesia for caesarean section. The use of Phenylephrine was associated with better fetal acid-base status, and there were no differences on Apgar score values and on the incidence of maternal bradycardia and hypotension

Evaluation of Gait Speed after Applying Kinesio Tape on Quadriceps Femoris Muscle in Patients with Knee Osteoarthritis

BACKGROUND: Knee osteoarthritis is a chronic degenerative disease, known as the most common cause of difficulty walking in older adults and subsequently is associated with slow walking. Functional decline, increased risk of falls and the presence of pain are, in many studies, related to the muscle weakness caused by osteoarthritis especially weakness of the quadriceps muscles. Many studies have shown that the strength of the quadriceps femoris muscle can affect gait, by improving or weakening it. Kinesio Tape is a physiotherapeutic technique, which reduces pain and increases muscular strength by irritating the skin receptors.AIM: This study aimed to verify if the application of Kinesio Tape on quadriceps femoris muscle increases gait speed while decreasing the time needed to accomplish the 10-meter walk test in patients with knee osteoarthritis and also in subjects without knee osteoarthritis.METHOD: In this study, we observed the change of gait speed with the help of the 10-meter walk test before, one day and three days after the application of Kinesio Tape in quadriceps femoris muscle. We compared the results of the time needed to perform the 10-meter walk in two groups. In the first group, the Patients group, participated 102 out-patients with a clinical diagnosis of primary knee osteoarthritis, while in the second group, the Control group, participated 73 subjects with a main excluding criterion a clinical diagnosis of primary knee osteoarthritis.RESULTS: Our results indicated that there was a significant decrease of time needed to perform the 10-meter walk test in both groups three days after application of Kinesio Tape on quadriceps femoris muscle. However, there was not a significant change one day after the application of Kinesio Tape compared before its application in both groups.CONCLUSIONS: Our results indicated that there was a significant decrease in time needed to accomplish the 10-meter walk test. Kinesio Tape is a technique that can be used especially when changing walking stereotypes is a long-term goal of the treatment

Physiotherapy Effects in Gait Speed in Patients with Knee Osteoarthritis

BACKGROUND: Knee osteoarthritis is a chronic degenerative disease, known as the most common cause of difficulty walking in older adults and subsequently is associated with slow walking. Also one of the main symptoms is a degenerative and mechanics type of pain. Pain is very noticeable while walking in rugged terrain, during ascent and descent of stairs, when changing from sitting to standing position as well as staying in one position for a long time. Many studies have shown that the strength of the quadriceps femoris muscle can affect gait, by improving or weakening it. Kinesio Tape is a physiotherapeutic technique, which reduces pain and increases muscular strength by irritating the skin receptors.AIM: The aims of this study was first to verify if the application of Kinesio Tape on quadriceps femoris muscle increases gait speed in patients with knee osteoarthritis and secondly if applying Kinesio Tape on quadriceps femoris muscle reduces pain while walking.METHOD: Seventy-four patients with primary knee osteoarthritis, aged 50 - 73 years, participated in this study. Firstly we observed the change of gait speed, while walking for 10 meters at normal speed for each patient, before, one day and three days after the application of Kinesio Tape on quadriceps femoris muscle, with the help of the 10 - meter walk test. Secondly, we observed the change of pain, while walking for 10 meters at normal speed for each patient, before, one day and three days after the application, with the help of Numerical Pain Rating Scale - NRS.RESULTS: Our results indicated that there was a significant increase in gait speed while walking for 10 meters one day and also three days after application of Kinesio Tape on quadriceps femoris muscle. Also, there was a significant reduction of pain level 1 and 3 days after application of Kinesio Tape, compared to the level of pain before its application.CONCLUSIONS: Our results indicated that there was a significant decrease in pain and increase of gait speed while walking for 10 meters. Kinesio Tape can be used in patients with knee osteoarthritis, especially when changing walking stereotypes is a long-term goal of the treatment

Technological innovations in physiotherapeutic rehabilitation

The study aims to understand the effectiveness of the technological innovations implemented in physiotherapeutic rehabilitation. In order to conduct this review during the search there were used keywords like robotic devices, mobile applications, virtual games and rehabilitation. 120 results were displayed, from which, after reviewing the preliminary titles, about 60 articles were deleted along with duplicates. From the review of the abstracts, 20 of them were selected after meeting the inclusion criteria. The articles have been selected from trusted sources such as PubMed &Wiley Library. Included in this review are all articles which consider the role of robotic devices, virtual games and mobile apps in physical rehabilitation. Also, excluded are articles that focus on the engineering and design part of games or articles that focused only on patient diagnostic equipment. The use of technological devices such as lokomat, exoskeletons and walkbots has shown effectiveness in the rehabilitation of patients by improving gait, speed and balance. Also, VR games and mobile apps promote the acceleration of rehabilitation time and patient engagement. The use of lokomat and VR enables effectiveness in physical rehabilitation in combination with conventional therapy. Mobile apps as a new tech approach should be further consider in new studies for their effectiveness as home rehabilitation form